Hyperinsulinemia and adypokines profile in patients with arterial hypertension and obesity

Abstract

One of the most important indicator of carbohydrate metabolism disorders and also an independent risk factor for hypertension is elevated blood fasting insulin concentration. Purpose is to study the role of hyperinsulinemia in the formation of adypokines profile disorders in hypertensive patients with concomitant overweight and obesity. Materials and methods. The study involved 72 hypertensive patients (21 men and 51 women), mean age 59,39 ± 1,61 years with overweight and different obesity degrees, of which 31 patients with overweight, 19 - 1 obesity degree , 15 - 2 obesity degrees, 7 - grade 3 obesity. To evaluate the contribution of different levels of insulin (especially hiperinsulinemia) in the development of clinical and metabolic abnormalities in patients with hypertension and elevated body weight patients, were divided depending on the content of fasting insulin on 3 tertile. In the first tertile (n = 24) - insulin levels ranged from 2.43 to 10.11 mkU/ml, in the second (n = 24) - from 10.2 to 17.55 mkU/ml, in the third (n = 24) - from 17.66 to 46.87 mkU/ml. Results. Comparison of anthropometric parameters revealed that the higher insulin levels associated with the higher waist circumference, BMI, and SBP. There were no statistically significant differences in DBP, HR levels, and lipid metabolism. However, changes of apoB were statistically significant and were characterized by elevation in tertile with medium to high levels of insulin compared with the lowest insulin tertile. The following adipokines were assessed: TNF-α, IL-6 and adiponectin. The activity of TNF-α increased according to the increase in the concentration of insulin (9.26±1.74 pg/ml, 13.52±2.75 pg/ml, 18.44±5.05 pg/ml, respectively). According to our data the level of IL-6 in different insulin tertiles did not significantly differ (11.73±0.51 pg/ml, 11.24±0.71 pg/ml, 12.22±0.28 pg / ml, respectively). The adiponectin characterized by decrease levels in 2 insulin tertile compared with 1 tertile (5.04±0.62 mg/ml vs 6.24±0.81 mg/ml, p<0.05) and more significantly decreasein in 3 tertile were observed (4.32±0.76 mg/ml). These effects may explain the ability of insulin to reduce the synthesis of adiponectin, which promotes insulin resistance tissues. Conclusions. Obtained results suggest that hyperinsulinemia in hypertensive patients with overweight and obesity related with of adipokines profile disorders. HyperTNF-alphaemia and hypoadiponectinemia result in progression of insulin resistance syndrome, which complicates the course of hypertension.